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Press Briefing Transcript

Telebriefing on U.S. Adult Vaccination Rates

OPERATOR: Welcome and thank you for standing by. At this time all participants are in a listen-only mode. During the question and answer session of the call, you may press star 1 to ask a question. Today's conference is being recorded. At this time we’ll turn the call over to Mr. Tom Skinner, you may begin, sir.

TOM SKINNER: Hello, joining us today for this telebriefing where we’re going to be discussing an MMWR article that was released today on non-influenza vaccination coverage among adults in the United States, year 2011. We are joined today by Dr. Howard Koh the Assistant Secretary for Health, Department of Health and Human Services, and Dr. Carolyn Bridges here from the CDC. Both will give some introductory remarks of about five minutes or so, and then we will move to your questions and answers. So Dr. Koh, I would like to turn it over to you at this time.

HOWARD KOH: Thank you very much, Tom, for recording this call, and welcome everybody. It is my great pleasure to be with you today. And as you all know we are currently experiencing a challenging flu season and many have recognized the threat of influenza and have come forward to be vaccinated, but while everyone knows about the importance of flu vaccine and childhood immunizations, on this call, we also want adults to be aware that there are other vaccines that protect them against serious diseases such as whooping cough and shingles, for example. We are presenting data shortly led by my CDC colleague Dr. Carolyn Bridges that shows once again that far too few adults are being vaccinated against these important diseases, and we need to do more. While we are seeing some modest gains in the coverage for two vaccines, particularly Tdap, that covers tetanus, diphtheria and pertussis and also human papilloma virus (HPV) vaccine. In general too few adults are taking advantage of the protection from vaccines leaving themselves and those around them at greater risk of vaccine-preventable diseases. You will be hearing much more detail from Dr. Bridges in just a second, but let me just stress that it’s important to send the message that vaccine-preventable diseases are critical to the future health of our country and they take a toll on our society.

So for example, with respect to invasive pneumococcal disease in 2011, the most recent year of data, there were some 37,000 cases, resulting in 4,000 deaths. The majority of cases and deaths occurred in adults 50 years or older, and the highest rates were seen among those 65 years or older. Almost everyone who gets invasive pneumococcal disease needs treatment in the hospital. Because of this CDC and HHS, Health and human Services department, recommend that older and at risk adults get the pneumococcal vaccine to help protect them against this potentially deadly disease. Another important example that you’ve probably already heard a lot about over the recent last few months is whooping cough or pertussis, and we have provisional data that estimate that over 9,300 cases have been seen in adults during 2012 and nearly 42,000 cases in total, and that’s the highest number that we have seen in this country in a single year since 1955. Tragically, 18 of those pertussis-related deaths have been reported up to January 5th of this year, and most of the deaths have been in infants younger than 3 months of age. When the source is identified, 4 out of 5 babies who got whooping cough caught it from someone in the home, a parent, sister or brother, grandparent or baby-sitter, so these are just some examples of why adult vaccinations are critical to the public health of our country. Some vaccines are recommended for all adults, others are recommended for people with certain medical conditions such as asthma, diabetes, heart or lung disease for example. So it is important to consult with your physician or health care provider about which vaccines you might need.

And this is a broad public health challenge that we can't ignore and everyone needs to be involved. At the federal level, I’m very pleased to chair a cross agency task force for the Department of Health and human Services working in concert with a number of large organizations to increase the number of adults who get their recommended vaccines. We also have the tremendous work of the national adult immunization summit. This is an ongoing collaborate of organizations committed to increasing the adult vaccination rates. This group includes many professional, medical, nursing, and pharmacist organization as well as vaccine manufacturers and distributors and still many others who are committed to the goal of improving vaccine coverage in adults. Of course, I should stress that Affordable Care Act is critically important here, because too many Americans don't get the preventive health care they need to reach their full potential for health, and the Affordable Care Act helps make preventive services including vaccines more affordable for people of all ages and all stages of life. I hope you all remember that under health reform, individuals who enroll in new group or individual health plans after September of 2010 don't have to pay any cost sharing for recommended preventive services including the vaccines that we are talking about today, and no cost sharing means no deductibles, and no co-pays and no co-insurance. So as I close out my remarks, I want to stress that we are encouraging all adults to talk with their health care provider about which vaccines are appropriate for them. You can also visit vaccines.gov to find out which specific vaccines you might need this year. We encourage health care providers to review vaccination needs with their patients at every visit. Adult vaccinations ensure the health of both the individual and the public, and we are committed to making prevention an easier option for everyone. So in that vein, we are also pleased to announce today the unveiling of a health map adult vaccine finder. This finder is available at vaccines.gov. If you go to vaccines.gov and look for the health map adult vaccine finder type in your zip code, and you can locate vaccine providers near you, and we are also encouraging all adult vaccine providers, physician, pharmacists and other providers to register in site. And as I finish let me acknowledge the many partners that were involved in this effort the Annals of Internal Medicine is copublishing the adult immunization schedule, and this new health map, adult vaccine finder was made possible by Boston’s Children's Hospital and Harvard Medical School. And I’d like to thank again the National Adult Immunization Summit and all of our partners in their ongoing collaborate for all the hard work their doing. So thank you very much and now it’s my great pleasure to turn the call over to my wonderful colleague Dr. Carolyn Bridges from the CDC.

CAROLYN BRIDGES: Thank you very much Dr. Koh. Today I’m going to provide a summary of some of the most recent estimates of adult vaccine uptake in the United States. The data I will share with you comes from the 2011 National Health Interview Survey also called the NHIS. The National Health Interview Survey is a cross sectional random household survey, every user conducted in respondent’s homes in person by US Census Bureau for the CDC’s National Center for Health Statistics. I am going to be highlighting information on vaccine uptick for six different vaccines. Pneumococcal vaccine, hepatitis A, hepatitis B, shingles or zoster vaccine, the human papilloma virus or HPV vaccine, and tetanus vaccine which include the Tdap vaccine, and this vaccine prevents tetanus, diphtheria and pertussis. Whooping cough as Dr. Koh said is another name for pertussis. The report published today does not include information on flu vaccine uptake, because this information has been previously reported and final season coverage for flu vaccine will not be available until September. The main finding from today's report is that despite modest gains for Tdap and HPV vaccine coverage from 2010 to 2011, the number of adults getting their recommended vaccines remains way too low.

For pneumococcal vaccines, there are two types of pneumococcal vaccine, the PPSV23 vaccine. This vaccine has been recommended for many years for adults and there is a new vaccine the PCV13 which was just recommended in the past year for adults with weakened immune systems and specific other groups. The coverage estimates in our report today however reflect only the PPSV23 vaccine uptake. All persons 65 years old and older are recommended to PPSV23 vaccine. This vaccine prevents severe illness caused by bacteria called streptococcus pneumonia or also called pneumococcus. Among adults 65 years and older coverage was just over 62 percent, nearly a 3 percentage point increase from 2010. More white 65 years and older received the pneumococcal vaccine at 67 percent compared with Asians at 40 percent, Hispanics at 43 percent, and blacks at 48 percent. Certain adults who are 19-64 years are also recommended to get the pneumococcal vaccine because they are at higher risk of severe disease from pneumococcal bacteria. Examples of conditions that make someone at higher risk include having a chronic health condition like heart disease, asthma, other chronic lung disease, diabetes, or smoking or having a weakened immune system. Among the high-risk adults 19-64 years, coverage was only 20 percent overall. This is about a two percentage point increase from 2010. More high risk whites received the pneumococcal vaccine at 20 percent compared to Asians at 12 percent and Hispanics at slightly over 18 percent. Coverage was 23 percent among blacks.

I like to turn now to the Tdap vaccine and again this vaccine provides protection against tetanus, diphtheria and pertussis. As Dr. Koh has mentioned we have seen large outbreaks of pertussis over the last year, and protecting adults from pertussis is not only important for protecting the adult who’s getting vaccinated, but it is also very important for preventing the spread of pertussis to others particularly for infants. All adults, especially those who will be near young children should get a Tdap vaccine. Adults should get this vaccine even if they were vaccinated as a child or if they have had pertussis in the past since neither prior infection nor prior vaccination provides lifelong protection. Also expectant mothers should get the Tdap vaccination during each pregnancy. They can safely get the vaccine at any time during pregnancy, but the vaccination is particularly recommended in the third trimester and this will allow the mother to pass the most amount of protection on to the baby. Compared to 2010, we saw modest gains in overall Tdap coverage compared to 2011 compared to 2010. Almost 13 percent of adults 19-64 years reported receiving a Tdap vaccine. This is about a four percentage point increase from 2010. The number of adults 19-64 years who were living with an infant under 1 year of age reported getting a Tdap vaccine increased about 11 percentage points to almost 22 percent. Again, this is important because infants under 1 are at increased risk of severe illness from pertussis. We also saw a 6.5 percentage point rise in the number of health care providers who received a Tdap vaccination bringing the percentage to nearly 27 percent. These coverage levels even with the observed gains remain well below where we would like to see them.

Let me now turn to the HPV vaccine. HPV vaccine protects against strains of HPV that cause about 70 percent of cervical cancers. For adult women not already vaccinated, the CDC recommends three doses of HPV vaccine by the age of 26. Ideally, this vaccine should be given during adolescence. We continue to see gains in the number of women 19-26 who have received one or more doses of HPV vaccine either as an adult or as an adolescent. During 2011, the percentage was nearly 30 percent and increased from almost 21 percent in 2010, and a further increase from 17 percent HPV coverage in 2009. That's very good news. Coverage for Hispanic women, however, was 20 percent. Continues to lag behind that for non-Hispanic white women which was almost 33 percent. Males up to the age of 21 are also recommended to receive HPV vaccine. This vaccine recommendation was made in late 2011 so this 2011 survey does not reflect any changes in uptake as a result of that recommendation. HPV vaccination coverage among males 19-21 years was just under 3 percent.

I’ll now turn to hepatitis A and hepatitis B vaccines. These vaccines are recommended for certain adults at increased risk of exposure to hepatitis A and B viruses. The proportions of adults who received the hepatitis A vaccine remains relatively unchanged from 2011 about 13 percent, as did the percentage of adults who had received the hepatitis B vaccine at 36 percent. This last year hepatitis B vaccine was also recommended for the first time in adults with diabetes. The number of adults age 19-59 with diabetes who reported getting at least three doses of hepatitis B vaccine also did not change significantly in 2011. That proportion was 27 percent. Whites had higher hepatitis B coverage nearly 38 percent compared with blacks 33 percent, and Hispanics at 29 percent.

The last vaccine I’ll discuss today is the zoster or shingles vaccine. Shingles occurs when latent varicella zoster or chicken pox virus reactivates later in life. Fifty percent of people who live to age 85 will develop shingles. The percentage of adults age 60 and older who reported receiving the vaccine increased to just under 16 percent. Whites had higher zoster vaccine coverage nearly 18 percent, compared with Asians at 14 percent, Hispanics 8 percent, and blacks at nearly 8 percent.

I'd like to take a few moments to put these numbers in perspective. While we are pleased to see any increase in adults getting their recommended vaccines, these numbers remain low overall. We have made little progress, and improving adult coverage from 2010 to 2011 and racial and ethnic disparities in coverage remains. These data highlight the need for continuing effort to increase the number of adults to get their recommended vaccines. People sometimes like to wait to get vaccines until they hear about outbreaks of vaccines like pertussis or flu in their state or community. I want to stress it is important to be vaccinated before disease arrives to get the most benefit out of these vaccines. Vaccines like pertussis and flu cannot only protect the person vaccinated from disease, but can also help protect family members and friends around the person vaccinated. As adult vaccines are becoming increasingly easier to access with vaccines offered at doctor offices, health departments, pharmacies, and other venues such as workplaces. I urge all adults to talk to their health provider about which vaccinations they need, and adults can go to the CDC website at cdc.gov/vaccines to find more information about adult vaccines. Tom, I’ll turn it back over to you.

TOM SKINNER: Shirley, I think that we are ready for the questions now, please.

OPERATOR: Thank you. We will now begin the question and answer session. If you would like to ask a question, please press star 1 and unmute your line and record your name clearly. To withdraw the request, press star 2. Again, star 1 to ask a question, and one moment for the first question.

Our first question comes from Mike Stobbe with the Associated Press. You may ask your question.

MIKE STOBBE: Hi. Thanks for taking my question. I was curious about Asian Americans. I see the sample sizes are smaller, but I was wondering if you could comment on, I see that in several of the categories, pneumococcal, tetanus, HPV, that Asian Americans were on the low end in terms of vaccination rates. They were high for hepatitis for some reason -- I was just wondering, what do you think is going on in that population?

HOWARD KOH: Well, we are concerned about health disparities about all racial and ethnic groups, and as Dr. Bridges mentioned these disparities persist in a number of the areas of adult vaccination schedule. So to tackle the disparities, we are trying to make sure that cost is not a barrier, and that is why the affordable care act provisions are so important. We are concerned about lack of awareness or lack of trust with the health care setting, cultural linguistic barriers, also, and these are all of the issues that we address when we try to tackle the disparities. I did want to point out that in the flu area; we are seeing elimination of those disparities for kids for the last couple of years. There no racial, ethnic disparities in the minority kids in respect to the flu vaccinations in the last couple of years and we hope to see it again this year, but the broader issue is for adults, mike, as you pointed out.

TOM SKINNER: Next question. Mike, do you have a follow-up?

MIKE STOBBE: No, I mean, I’d love a little bit more specificity regarding the Asian Americans, and any thoughts more specifically about that group, Dr. Koh?

HOWARD KOH: Well, we are particularly interested this the hepatitis b vaccine issue for Asian Americans, and I don't know if dr. Bridges has more data to share, but that is one area where they are at a particular high risk and we know that hepatitis b can lead to chronic liver failure and liver transplant and liver cancer which are growing issues in the particular Asian American population, so that is an important theme for the particular population, but I don't know if dr. Bridges has more information on that specific area.

CAROLYN BRIDGES: No, no, I don't. I don't think that we understand all of the factors that influence the vaccine uptake, but maybe attitudes about the preventive care and vaccines in general and the propensity to seek vaccinations.

ALEX WAYNE: Hi. Thank you for doing this call. I was just wondering a rudimentary question, but what level of vaccine is considered sufficient to protect for population protection and what percentage of people should be vaccinated? Thanks.

CAROLYN BRIDGES: This is Carolyn Bridges, and that proportion will differ by different vaccines, and different populations. So there are some healthy people 2020 goals that we have for some of the vaccines. We certainly are far below those goals for all of the vaccines, and, you know, as we have talked the vaccine coverage level for all of the vaccines are really way too low.

ALEX WAYNE: Could you tick off some of the goals for pneumonia, whooping cough, and that sort of thing?

CAROLYN BRIDGES: Sure. The goal for pneumococcal vaccine for high risk is 19-64 years is 60 percent. The goal for people 65 and older for pneumococcal vaccine is 90 percent. The goal for zoster vaccine for people 60 and older is 30 percent. And the goal for hepatitis b coverage for health care workers is 90 percent. So, we didn't talk about the coverage level for health care workers, but it is in the report for hepatitis b vaccine. That coverage level is about 64 percent. So we haven't made any of the healthy people 2020 goals for any of the four target areas. We don't have healthy people 2020 goals for each of the vaccines.

TOM SKINNER: Okay. Next question, Shirley.

OPERATOR: Thank you. As a reminder, if you have a question press star 1. The next question comes from Lisa Schnirringwith CIDRAP, and you may ask your question.

LISA SCHNIRRING: Hi. Thanks for taking the questions today. I was wondering about the shingles vaccine and what you think might eventually happen with that? I know that the vaccine supply was pretty tight and pretty new vaccine, but you'd think that in the next several years they may drop the age to, you know, for when that is recommended? Thanks so much.

CAROLYN BRIDGES: Yes. Thanks for the great question. There certainly have been difficulties with the supply for zoster vaccine, and that is what may be reflected in the coverage levels that we see for 2011. But in the last about year, we've noticed a much less difficulty with supply, and haven't heard any difficulties with the supply for zoster vaccine over the last several months, so we are really hoping that we will start seeing some increase in the coverage for zoster vaccine over the next year or so. Sorry, you had a second part of the question.

LISA SCHNIRRING: Yeah. I was wondering if they may lower the age of when it is recommended to give that vaccine? I know that, you know, talking to friends and associates and stuff, a lot of people say, I wish I could get that vaccine, because it sounds like one of the most miserable illnesses you can get. So, it is -- I’m just curious about that.

CAROLYN BRIDGES: Well, I know it is -- likely something that ACIP is going to take up in their deliberations particularly now that again supply does not appear to be as much of an issue certainly as it was. Sorry, the ACIP is the advisory committee on immunization practices. This is a federal advisory committee to CDC that puts together the new vaccine recommendations for the civilian population.

TOM SKINNER: Next question, Shirley.

OPERATOR: Thank you. The next comes from Kate Traner with AJHP. You may ask your question.

KATE TRANER: Thanks for taking the question. I was reading an MMWR article and in the editorial note it recommends standing order programs for vaccinations, and I know those are often used for the pneumococcal and flu vaccines, but I don't hear them about other adult vaccines, so I’m wondering is this an official recommendation from the CDC that the programs get expanded beyond just flu and pneumococcal?

CAROLYN BRIDGES: Well, that is a great question. Of course, we know that using sustaining program orders does work in increasing vaccinations and having the systems in place in the offices so that vaccination review is done in every visit so that you don't have a missed opportunity for vaccination. There are issues with certain types of insurance, particularly Medicare covering most flu and pneumococcal vaccine, and the tetanus vaccine for treatment, hepatitis b for high-risk persons, so usually the standing orders can be little bit more complicated depending upon the insurance that is being used, but certainly for routine practice and doing that routine assessment, figuring out how to incorporate vaccines into the routine care for adults is really important for raising coverage.

HOWARD KOH: I want to echo what dr. Bridges said about trying to build better systems. One of the purposes of this call is to try to support efforts to build better systems for adult immunization in general and not just the flu, but the adult vaccinations that we are mentioning on the call. So if you can build a better system across the country for this, we will advance prevention, and public health in a substantial way.

KATE TRANER: Okay. Is this something that the ACIP may take up or something that the CDC might strongly call for? Because it seemed like an offhand, by the way, this ought to be done in the editorial.

CAROLYN BRIDGES: Thank you. We are working very closely with the national adult immunization summit, so all adults seek care in a lot of different locations, so we have a wide range of partners that are really working very hard to increase awareness of the adult immunizations to work with different medical, pharmacy, nursing and other provider groups to try and encourage ways to have vaccines become more routine for adults. It is very routine in the pediatric practice, but the adults don't get vaccinated as much. And we really appreciate all of your efforts to help raise awareness about the need for adult immunization. But it is going if to -- it is going to be a process.

OPERATOR: At this time, I am showing no further questions. If you would like to ask a question, press star 1 for a question. One moment please for the next question. One moment please. Our next question comes from Yurina Melara from LA Opinion.

YURINA MELARA: Thank you for taking my call. What can you tell us about the hispanic immunization rate. I don't know if you have it broken down into demographics.

CAROLYN BRIDGES: Thank you for the question. This is Carolyn Bridges. If you look in the report that just came out today for each of the different vaccines that we are reporting on today, there is an estimate of coverage for the total population, whites, blacks, Hispanics, Asians and other. The other category includes Alaska natives, American Indians and others are people who report multiple ethnicities. Is there a particular vaccine that you wanted to know the coverage on for hispanics?

YURINA MELARA: Well, overall, are the Hispanics getting vaccinated?

CAROLYN BRIDGES: Well, in general for adult vaccine, the coverage among Hispanics is lower, and you know, it is an area of real concern and something that I know that Dr. Koh is very interested in. There have been a lot of effort to reach out to the Hispanic community an increase awareness about vaccines.

YURINA MELARA: Do we know why? Is there fear involved? Lack of access to services? Why are we seeing this?

CAROLYN BRIDGES: CDC is going to be doing more research to try to understand what the reasons are, and how we might go ahead to increase the vaccination rates in Hispanics and other racial groups, but this is most likely multi-factorial and may involve attitudes to vaccines, and access to vaccines and other -- we also know that Tdap for pregnant Hispanic women is really important. We want to make sure that all women are getting the Tdap vaccine and we have noticed an increase of risk of pertussis in the infants of Hispanic women. So very important to get that recommendation out.

OPERATOR: And at this time I will turn the call back over to Mr. Skinner.

CAROLYN BRIDGES: This is Dr. Bridges. I just want to close by saying, you know, we recognize that the adult immunization schedule is complicated. Knowing which vaccines somebody needs is not easy. That is why we want to really encourage the public to go see their health care provider and ask them about the vaccines they need, and we really want to encourage health care providers to make sure they routinely assess the patients for the vaccines they need, and there are a lot of tools out there for patients and providers to know about what the current recommendations are. Patients can go on the CDC website, cdc.gov and search on adult vaccine quiz, and that is which to figure out which vaccines you need. And we are thankful as Dr. Koh mentioned that the annals are a great partner in publishing the results in the annals, and MMWR as well. Go out there and know what vaccines you need to not only protect yourselves, but the people around you.

TOM SKINNER: Dr. Koh, do you have any final thoughts?

HOWARD KOH: Well, Dr. Bridges said it all and we are very grateful to everyone's attention to this, and we are hopeful to see a future where prevention is prioritize and we build better bridges. I wanted to comment on the theme that we trying to identify better efforts with respect to tracking vaccination through immunization registries using electronic health records to get that information available to providers on a timely manner. And those processes and those efforts will advance these rates in the future along with a lot of the other efforts that dr. Bridges summarized.

TOM SKINNER: Thank you very much. This concludes our call, and individuals wanting a copy of the report can call the CDC press office at 404-639-3286 to receive a copy of the report and anyone with follow-up questions can call that same number, and we will be happy to answer your questions. So thank you all for joining us today.

OPERATOR: Thank you. This does conclude today's conference, and we thank you for the participation. At this time, you may disconnect your lines.